Parental Involvement When Conducting Cognitive-Behavioral Therapy for Children With Anxiety Disorders

Abstract

Discusses the potential roles of parents in cognitive-behavioral therapy (CBT) with anxious youth and how parents can both facilitate and/or impede treatment progress. Parents facilitate the attainment of treatment goals by providing invaluable information regarding the child's level of functioning and assisting the therapist with the development and implementation of treatment components such as exposure tasks. Parental involvement in treatment also gives the therapist an opportunity to more fully assess and address family factors that may be maintaining the child's anxiety. Common challenges encountered with parents that may impede treatment progress include rescuing the child from anxious situations, under- or overinvolvement in the treatment process, difficulty setting limits, and the presence of parental psychopathology. Finally, the relevance of developmental level, child gender, diagnosis, and the presence of parental psychopathology to the decision of how and when to include parents in treatment is discussed. Keywords: cognitive-behavioral treatment; youth; parental involvement Research suggests that parental factors play a role in the development and maintenance of anxiety symptoms in youth (for a review see Ginsburg, Siqueland, Masia-Warner, & Hedtke, 2004; Wood, McLeod, Sigman, Hwang, & Chu, 2004). For example, parents of anxious youth appear to indirectly and directly encourage maladaptive patterns of responding to anxiety-provoking situations through direct discussions with their children (Barrett, Rapee, Dadds, & Ryan, 1996; Dadds, Barrett, Rapee, & Ryan, 1996), modeling anxious behavior themselves (Whaley, Pinto, & Sigman, 1999), and exhibiting overcontrolling and intrusive behaviors (Dumas, LaFreniere, & Serketich, 1995; Hudson & Rapee, 2001; Krohne & Hock, 1991; Siqueland, Kendall, & Steinberg, 1996; Suveg, Zeman, Flannery-Schroeder, & Cassano, 2005; Whaley et al., 1999). Given these factors, treating clinicians are often faced with the question of when and in what capacity to include parents in the treatment process. Kendall (2000) discusses three ways in which parents may be involved in treatment programs for anxious youth. As "consultants," parents primarily provide the therapist with more information regarding the nature of the child's anxiety. For instance, a parent in a consulting role might reveal to the therapist particular factors that exacerbate the separation-anxious child's anxiety when she goes to school in the morning. As "collaborators," parents actually help carry out the treatment components. A parent-as-collaborator might implement an exposure task in which the separation-anxious child rides the bus to school instead of having the parent drive them to school. Finally, as "coclients," parents are involved in the treatment to the extent that they are exhibiting behaviors that are believed to be contributing to or maintaining the child's anxiety. For instance, an anxious parent might be encouraged to develop and implement a plan for managing their own anxiety upon separation from the child. Arguably, all parents are involved in the treatment of anxious youth in some capacity, whether as consultants, collaborators, coclients, or a hybrid thereof. Indeed, parents need not be in the actual therapy room to be important members of the treatment "team" along with the therapist and child. The goal of this article is to consider the ways in which parents might facilitate and/or impede the attainment of treatment goals. Strategies to manage challenging clinical situations are presented. Lastly, the empirical literature examining for whom (e.g., younger children) and under what conditions (e.g., parental psychopathology present) family involvement might be most beneficial is briefly reviewed. THE CASE FOR PARENTAL INVOLVEMENT This section reviews some of the specific benefits that may be gained by including parents in the treatment process. …